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Pharmacology > Diabetes & Thyroid Drugs > Flashcards

Diabetes & Thyroid Drugs Flashcards

1
Q

Rapid-acting: Lispro Insulin (onset, peak, duration)

A

Onset: 15-30 min
Peak: 0.5-3 hr
Duration: 3-5 hr

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2
Q

Short-acting: Regular Insulin (onset, peak, duration)

A

Onset: 30min -1 hr
Peak: 1-5 hr
Duration: 6-10 hr

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3
Q

Intermediate-acting: NPH (onset, peak, duration)

A

Onset: 1-2 hr
Peak: 4-14 hr
Duration: 14-24 hr

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4
Q

Long acting: Glargine, Detemir (onset, peak, duration)

A

Onset: 1-4 hr
Peak: none
Duration: 24 hr

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5
Q

Insulin Therapeutic Use

A

Glycemic control of diabetes mellitus (type 1, type 2, gestational)
Clients with type 2 diabetes can require insulin when:
- oral anti diabetic meds, diet, and exercise or unable to control blood glucose levels.
-severe renal or liver disease is present
-painful neuropathy is present
-undergoing emergency treatment of diabetes keto acidosis (DKA) and hyperosmolar hyperglycemia nonketotic syndrome
-Requiring treatment of hyperkalemia

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6
Q

Insulin Adverse Effects

A

Hypoglycemia (blood glucose < 70 mg/dL)
Hypokalemia
Lipohypertrophy

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7
Q

Manifestations of Hypoglycemia

A

-headaches, disorientation, lethargy
-tachycardia, palpitations
-diaphoresis, shakiness (tremors)

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8
Q

Manifestations of hypokalemia

A

-Confusion, lethargy
-shallow breathing, dysrhythmia
-N/V, weakness

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9
Q

Insulin Interactions

A

Alcohol and beta blockers add additive effect
Thiazide diuretics and glucocorticoids increase blood glucose thereby counteracting effect
Beta blockers can mask symptoms of hypoglycemia

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10
Q

Pharmacological action:
Sulfonylureas (chlorpropamide, glipizide)

A

Insulin release from the pancreas; can increase tissue sensitivity to insulin over time

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11
Q

Pharmacological action: Biguanides (Metformin)

A

Reduces the production of glucose within the liver through suppression of gluconeogenesis
Increases glucose uptake and use in fat and skeletal muscles
Decrease glucose absorption in the GI tracts
First choice medication for most clients who have type 2 diabetes

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12
Q

Pharmacological action: Thiazolidinediones (Pioglitazone)

A

Increases cellular response to insulin by decreasing insulin resistance
Increases glucose uptake and decreased glucose production

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13
Q

Pharmacological Action: Alpha-glucosidase inhibitors (Acarbose)

A

Slows carbohydrate absorption and digestion
Miglitol was particularly effective for clients of Latino or African heritage in clinical trials

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14
Q

Pharmacological action: Dipeptidyl peptidase-4 (DPP-4) inhibitors (gliptins)

A

Augments naturally occurring in retain hormones, which promote release of insulin and decrease secretion of glucagon
Lowers fasting and postprandial blood glucose levels

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15
Q

Glipizide adverse effect

A

Hypoglycemia
Weight gain

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16
Q

Metformin adverse effects

A

Gastrointestinal effects (anorexia, nausea, and diarrhea- weight loss)
Vitamin B12 and folic acid deficiency
Lactic acidosis (myalgia, malaise, somnolence, and hyperventilation)
May cause metallic taste

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17
Q

Pioglitazone adverse effects

A

Fluid retention
Elevations in LDL cholesterol
Hepatotoxicity
Ovulation in females who had been anovulatory (perimenopausal)

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18
Q

Acarbose adverse effects

A

GI effects (abdominal distensión and cramping, hyperactive bowel sounds, diarrhea, excessive gas)
Anemia due to the decrease of iron absorption
Hepatotoxicity with long-term use
Impaired breakdown of sucrose

19
Q

Sitagliptin adverse effect

A

Can cause pancreatitis (rare)

20
Q

Oral anti diabetic drug Precautions/contraindications

A

Caution in clients with heart and renal failure, liver dysfunction, or are pregnant

21
Q

Metformin contraindication/precaution

A

Clients who have severe infection, shock, kidney impairment, and any hypoxic condition
Should not be used by someone with alcohol use disorder

22
Q

Acarbose Precaution/Contraindication

A

Clients who have GI disorders (inflammatory disease, ulceration, or obstruction)

23
Q

Pioglitazone precautions/contraindication

A

Clients who have severe heart failure, history of bladder cancer and active hepatic disease
Use caution in those with mild heart failure

24
Q

Sitagliptin precautions/contraindication

A

Upper respiratory tract infection
Should only be used in pregnancy if clearly indicated

25
Q

Glipizide Drug interactions

A

NSAIDs or beta blockers —> Additive hypoglycemic effect

26
Q

Metformin Drug interactions

A

Alcohol or cimetidine —> lactic acidosis

27
Q

Pioglitazone drug interactions

A

Insulin —> fluid retention

28
Q

Nursing Implications on antidibetic drug

A

Assess client before administration
-ability to consume food
-nausea or vomiting (can be a sign of low blood sugar)
-diet status
—if NPO, clarify order for anti diabetic drug therapy
Assess blood glucose levels before drug administration
-insulin requirement may increase due to stress, infection, illness or trauma, pregnancy, or lactation

29
Q

Administration

A

Subcutaneous injection sites
Needle, gauge, syringe selection
Mixing and drawing up insulin
Timing of insulin dose with meals

30
Q

Nursing implications

A

Give oral anti diabetics 30 min before meals
- Give Metformin with meals
Discontinue Metformin if client is to undergo studies with contrast dye
Assess for hypoglycemia
- if present, give glucose elevating drugs
Monitor therapeutic response
-Blood glucose levels, HbA1C
-Manifestations of hypoglycemia or hyperglycemia

31
Q

Levothyroxine action

A

Synthetic form of thyroxin (T4), liothyronin (T3) and combo of T3 and T4
- increase metabolic rate and protein synthesis
-increase cardiac output and renal perfusion (blood flow through kidney)
-increase body temperature
-oxygen use
-blood volume and growth processes

32
Q

Manifestations of hypothyroidism

A

Drowsiness, lethargy, confusion
Bradycardia
Anorexia, weight gain, edema
Constipation
Fatigue, weakness
Intolerance to cold
Dry, sparse coarse hair
Depression

33
Q

Levothyroxine Adverse effects

A

Thyroid storm (when thyroid levels are too high)
- Tachycardia, palpitations, chest pain
- increased blood pressure
- Anxiety, nervousness, tremors, insomnia
- Weight loss
- heat intolerance
Long term use of medication
- osteoporosis

34
Q

Levothyroxine Contraindications

A

Caution in clients with hypertension
Caution in clients with diabetes
Not for use in the treatment of obesity
Contraindicated for clients who have thyrotoxicosis and adrenal insufficiency

35
Q

Levothyroxine Interactions

A

Decrease effectiveness of insulin
Increases excretion of digoxin
Increases effects of warfarin
Food decreases absorption of Levothyroxine ( take an hour before breakfast)
Antacids, iron, and calcium supplements reduce absorption therefore levothyroxine should not be taken within 4 hours of these medications

36
Q

Levothyroxine nursing implications

A

Obtain baseline vital signs
monitor for tachycardia and irregular pulse (check apical pulse)
Daily therapy begins with a low dose that increases gradually over several weeks (full effect of medication can take 6-8 weeks)
Monitor T4 and TSH levels
Medication is dosed in micrograms

37
Q

Client teaching Levothyroxine

A

Notify provider if heart palpitations, chest pain, or symptoms of thyroid store are present.
Do not discontinue. Therapy is lifelong
Notify provider before switching to to another brand. Dosage adjustments
Take medication on empty stomach 30 -60 min before breakfast

38
Q

On the test

A

Metformin
Levothyroxine
Thyroxine
Acarbose : when should they take
Know peaks for medication ex. Insulin
Lab values what they are related to Hemogloblin A1C
Know lab values for blood sugar fasting
When someone is hypoglycemic we can give them juice (higher intake of protein and lower intake of carbohydrates)
Metoprolol - diabetes action
If pt is awake and blood sugar is low … give oral medication first then IV
Thyrotoxicosis - one question on exam
Glucose elevating drugs : management of hypoglycemic reaction
- oral concentrated glucose
-intravenous dextrose in water (D5W)
-Dextrose 50% (D50)
-Glucagon
—- subcut, IM, IV
Question on hyperglycemia and what are you gonna do
Know what food to eat with hypothyroidism (focus on weight gain, edema, constipation) : Grains, leafy greens
Avoid foods in high in iodine because of the medications (PTU or methimazole) <— these are given with
Give PO with Insulin
Oral anti diabetic drugs you take the pill with the food
Insulin is given to pt with hyperglycemia —- take food within the onset of action
Hypoglycemia- does not have to be taken with food (their blood sugar is low)
PTU is safe for pregnancy

39
Q

Can levothyroxine be crushed ?

A

Yes, levothyroxine can be crushed because it is not extended-release, sublingual, or enteric-coated. If crushed the medication should be mixed with 5 to 10 mL of water.

40
Q

Propylthiouracil for client who is pregnant

A

This medication is used to treat hyperthyroidism during the first trimester or pregnancy bc it does not cross the placental barrier well.
Methimazole is the preferred medication in the second and third trimesters of pregnancy.

41
Q

Levothyroxine Administration

A

Give orally to treat hypoglycemia and IV to treat myxedema coma
Give daily on an empty stomach (30-60 min) before breakfast with a full glass of water
Monitor for cardiac excitability
Expect lifelong replacement therapy
Instruct client to notify provider if medication has changed its brand to a different levothyroxine product
Food reduces its absorption

42
Q

A nurse is teaching a client who has hyperthyroidism about managing this disorder.

A

Increase caloric intake with meals
Explanation: clients whose thyroid hormone levels are high have increase protein, lipid, and carbohydrate metabolism resulting in loss of protein stores. Meeting energy demands is difficult and weight loss is common.

43
Q

Interactions with oral antidiabetic drugs

A

Sulfonyureas (glipizide, glyouride), Thiazolidinediones (pioglitazone), and metformin, can all be taken together

Acarbose, can be taken with sulfonyureas and metformin

Sulfonylureas should not be taken with insulin

Sitagliptin, should not be taken with insulin due to hypoglycemic effect

Pharmacology (5 decks)

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